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GPs requesting ambulance will have to provide a score for level of emergency

GPs and other healthcare professionals requesting emergency ambulances for patients across England will have to provide a 'score' or clinical reason for calling from next month. 

The BMA has warned these new rules could risk patient safety and has said they 'must not' be used as a barrier to accessing an emergency ambulance. 

It comes after a Pulse investigation found that patients who need an ambulance at a GP surgery are routinely facing waits twice as long as patients who call 999 from elsewhere.

A National Early Warning Score (NEWS) is calculated based on the severity of symptoms. It was first produced by the NHS in 2012 and was updated to the latest version in December 2017 to deliver a more standardised response to acute illnesses.

The latest version - called NEWS2 - is an assessment of the six vital signs: respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion and temperature. The GP will be expected to give each factor a score, with a higher number reflecting how much the symptoms vary from the norm. 

The guidance from NHS England said: 'This information should be communicated to ambulance dispatch when requesting an ambulance. If possible the patient’s NEWS2 score is to be calculated, recorded and also handed over to ambulance clinicians and upon arrival in the receiving unit.'

A NEWS2 of seven or more may trigger a level 2 ambulance response time, which is 18 minutes. But if the score is less than seven or unknown, the GP or HCP will be asked to give the clinical reason for calling an ambulance.

A level 1 ambulance response time, which is seven minutes, is reserved for life-threatening conditions requiring immediate assistance like cardiac arrest, cardiovascular collapse, and airway compromise.

A NEWS2 is not required where the patient is under 16 years and/or pregnant or in ‘exceptional circumstances’.

The new guidelines have been issued by NHS England and NHS Improvement, after pilots were successfully run by the North West and West Midlands ambulance services. The pilots will now be rolled out nationally for all ambulance trusts to implement.

The BMA said the new guidelines could compromise patient safety.

BMA GP Committee deputy chair, Dr Mark Sanford-Wood, said: ‘GPs have had concerns about the pressures their colleagues in ambulance services are under and the impact this can have on response times. Whilst this guidance aims to improve the current situation it must not add to the burden already carried by clinicians working hard to care for patients in urgent situations.

‘Given the pressure that GP services are currently under it is important to note that the guidance relating to NEWS2 scoring is not obligatory and must not be used as a barrier in accessing this vital service and that crucially patients are able to access the urgent care they need.’

Other information that will be required when making a call to an ambulance includes:

  • Patient demographics (name, DOB, NHS Number, address, etc)
  • Mobility (e.g. walking, wheelchair, stretcher)
  • Infections/risk of infection
  • Clinical interventions necessary and escort requirement
  • If the patient can travel in an ambulance with other patients
  • Booking HCP’s direct telephone number, name and role or deputy
  • Patient’s telephone number (admissions)

The guidance highlighted that while a dedicated phone number for HCPs will be set up, they can still call 999 in immediately life-threatening emergencies.

It follows the death of a child who died after an ambulance took an hour to reach her at a practice in Cardiff, despite a GP requesting paramedics arrive within eight minutes

Readers' comments (38)

  • This is not how NEWS 2 is supposed to be used and there is no evidence to support this being appropriate. NEWS 2 is to look for people who might be more ill than you suspect, not those obviously unwell.
    We all know the real problem- ambulances tied up with total BS but rather than address the real problem they put more pressure on, you guessed it, GPs

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  • While members of public calling 999 may not realise how serious the problem is, you can be sure if a doctor is calling an ambulance they are justifiably concerned. So in fact if a GP calls 999 it should be the highest priority.

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  • This is why I respect NHS England so much. Its the never-ending shower of ill-thought out crap that is so reassuring.

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  • So the smoker with chest pain, an ischaemic ECG but normal obs gets denied an ambulance ? Isn't modern medicine wonderful.

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  • So while NHS111 clinical experts continue to send almost everyone they speak to into urgent care / OOH and continue to request ambulances at the dup of a hat, wasting vital resources, GPs have to go through this nonsense. As usual NHS England at its best

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  • NHSE really, really hate GPs don't they (sorry if I'm late to that particular realisation)? Why on earth would you put a barrier in place to request an ambulance when they've been assessed by someone trained and experienced. Unless of course it's to continue the subtle drip feed that GPs are the problem "by requesting ambulances more urgently than they should etc etc". Patient who stubs their toe and tells 111 they have a pain score of 10 will have an ambulance at the door before they've put their shoes on, whereas if I need an ambulance for an ill patient, I have to jump through hoops, calculate meaningless scores, and probably wait longer for it to arrive because they deprioritise patients at a GP practice.

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  • Service is collapsing, desperate measures. Nothing but sympathy for the poor ambulance teams. Underinvestment everywhere, and poor senior management in some areas.
    Answer for us is simple, surely: everything that needs an immediate response is a 10; everything else is a 7. General practice can’t run if we or our staff are expected to sit with patients for 4 hours waiting for an ambulance.

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  • Excellent: tick enough boxes get what you want, use your training/knowledge/common sense of many years and your stuffed!

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  • I think if a GP calls for an ambulance via 999 then there is probably a need for one - ?
    Will everyone in ivory towers addicted to protocols and scores get off there arses and smell the coffee in the real world.
    I would simply suggest to the ambulance that if a GP calls then NEWS2 = 10 and go!

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  • Actually there is good evidence for the use of NEWS2 in primary care.
    1. It reduces mortality and length of stay.
    2. It aids identification of a group of patients at high risk of sepsis
    3. It improves communication.
    4. A news score of 5 at one point which then deteriorated to 7 or more in an hour is a very sick patient
    5. It allows identification by the ambulance service of those patients it needs to respond to soonest
    6. a patient with a NEWS2 score of 5 should be in hospital within the hour and if 9 then within 30 minutes

    This is a good example of the implementation of (emerging) evidence based medicine.
    Don’t use it at the peril of your patients

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